July 1 is a day that marks the new era when student truly becomes doctor, where hundreds of residency programs start day one of the three-year or longer residency, a life-changing rite of passage. Where the initial hours start the tens of thousands of hours of experiential full immersion training. Looking back, intern year was one of the hardest years of my training and definitely one of the hardest years of my life.
I remember my first day well. I was on call in a busy inpatient medicine service at our main university hospital, where we took care of the sickest of the sick, the underserved, the uninsured. I remember my trepidation at every order I wrote (back then on paper charts) and how meticulous I was at gathering each piece of data from the patient and from the diagnostics that were so carefully chosen. I distinctly remember one of my first patients as a homeless gentleman who had a septic knee. As my seasoned resident was teaching and supervising me in performing the joint arthrocentesis, the patient was very irritated and attempted to kick me. I remember thinking, “What did I get myself into?” Incredulous and yet humbled, I remained determined to do what was best for the patient.
Perhaps this kick was a metaphorical prophecy for what was to come. The three years that followed included intense life sacrifice, to practice the art of medicine, combining the objective classroom and lower responsibility of on-site learning from medical school with the actual physical act of practicing taking responsibility for the care of other human beings in need. Residency literally and figuratively kick-started my life in a way where I felt honor, pride, gratitude, and the alignment of my main goal at the time: to help other human beings as a physician. With every year that I matriculated, more and more responsibility, and more leadership roles were thrust into my immediate sphere. I became a skilled and trusted clinician in the residency program; I was chosen to be a chief resident after I graduated.
Looking back 16 years later, and for those starting this harrowing rite of passage, I wished I knew some hard-earned lessons beforehand that are still applicable to junior, mid-career, and senior physicians.
1. Rather than “eat when you can, pee when you can, sleep when you can,” you must for the sake of your patients, and the rest of your team, and most importantly yourself, take care of you. You likely took an oath to do this with the line: “I will attend to my own health, well-being, and abilities in order to provide care of the highest standard” as written in the Revised Declaration of Geneva a.k.a. a Modern-Day Physician’s Pledge in 2017. This line had been long overdue. If you need to attend to your basic bodily needs, do so, as a priority. If this competes with your work as an intern or resident, let your resident or attending know to help arrange for temporary coverage. After cancer and birthing two babies, you absolutely cannot care for others unless you care for yourself. As you matriculate into becoming a resident supervising a team, prioritize your intern and co-resident’s needs for self-care, and most importantly, your own. With this proper alignment of priorities, and support to honor those priorities, I believe that medicine can remain filled with the whole-hearted compassionate individuals that were hand-picked, who are full of self-compassion as the norm, rather than the exception.
2. Shame, ageism, racism, sexism are still embedded in the culture of medicine. When you face it, know that you are not alone. Speak up and speak out if you experience it and if you witness it, as uncomfortable as that may be. You have been inducted into a sacred profession that is imperfect. You can concurrently know this about the profession and be intentional about being the change you want to see. Don’t remain complicit and silent.
3. Don’t forget to celebrate wins, and have fun. While the next few years of your life are going to be hard, perhaps especially intern year, your tendency as a human to hold onto negative events such as errors, or unanticipated outcomes will be magnified, and threaten at times to consume your existence. Self-flagellation will only harm. Seek out a support system, if the program does not already have one, a debriefing system, and then build in time for acknowledgment of wins, and transitions. Sick patient that you helped get better? Pause and acknowledge. You are doing the work and helping. This will happen more often than not in your day to day, but you must remember to pause and acknowledge to strengthen your capacity to allow and accept positive outcomes as well. This will help you move through and overcome the harder, more difficult circumstances.
4. Embrace the experience fully because while it was one of the hardest years of my life, it also was one of the best years of my life—the relationships formed during intern year have the potential to become lifelong friendships. The human bonds that form intern year are simultaneously powerful and vulnerable. The shared common humanity of your experience with that of your fellow co-interns runs deep and has such a precious uniqueness that will most likely not be experienced again. Relish in the bonds that are forged.
Congratulations on making it to residency. It’s day one of time protected for you to reside in the concurrent comfort and discomfort of growing into your own practice of medicine.
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